Check to ensure the following required documents are included in the envelope:

Transcription

1 Delta Sigma Theta Sorority, Inc. Orange County Alumnae Chapter Eminence Gala P. O. Box Orlando, FL EMINENCE 2018 INFORMATION PACKET APPLICATION & CHECKLIST Complete package due by October 15, 2017 Submit all required documents in the same envelope Check to ensure the following required documents are included in the envelope: An autobiographical essay ( words) or video reel (less than 3 minutes). Sealed Letter of Recommendation from a School Official (form provided in this packet) Sealed Letter of Recommendation from a Non-School Official (form provided in this packet) Non-refundable application fee of $ Signed Application Signed Risk Management Forms Eminence Gala xxxxxxxxxxxxxxxxxxx Page 1 of 12 (v617)

2 ABOUT EMINENCE Eminence is a youth development and incentive program sponsored by the Orange County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. as part of the sorority s national five-point program. High school juniors and seniors from the greater Orlando metropolitan area partake in activities designed to enhance their academic, social, cultural and civic awareness. The program is designed as a rite of passage experience and culminates with a formal presentation of these outstanding youths to society. For the past twelve years, the Orange County Chapter of Delta Sigma Theta Sorority, Inc. has been pleased to offer the Eminence Gala as a premiere social event in the Central Florida community. By recognizing high achieving junior and senior students for outstanding scholastics, extracurricular involvement and participation in community service endeavors; we have successfully provided approximately $152,000 in support of continued education. During the Gala, special recognition and incentives are awarded to the top three revenue-generating Debutantes or Distinguished Gentlemen. Each participant will receive fifty-percent of the proceeds for their incentive award (In 2017, our Honorees were awarded over $2,000 each). Highlights of the event include the presentation of the formally attired debutantes and distinguished gentlemen to society and their long-awaited signature dance of the evening. This time-honored tradition is more than just a coming out ceremony. An exacting regime of community service and personal improvement precede the night of elegance. The ladies and gentlemen who express a desire to participate and who are subsequently accepted participate in a number of events such as, Honoree luncheon, numerous workshops in etiquette, financial management, interview techniques and various other topics. In addition, they will attend cultural activities and participate in bonding activities. As a demonstration of commitment to social responsibility honorees will plan and implement a community service project before beginning their dance instruction and final preparations for their societal debut. The Eminence Gala is a dazzling evening of fine dining, dancing, and socializing with the Debutantes, Distinguished Gentlemen and dignitaries filling the observer s eye with beauty and pride! Are you ready to become a part of a stellar program and make Eminence History? We take pleasure in providing this program to the Central Florida community and we hope you enjoy the journey! Eminence Gala xxxxxxxxxxxxxxxxxxx Page 2 of 12 (v617)

3 ELIGIBILITY AND REQUIREMENTS: Attend the Student/Parent Risk Management Orientation: Sunday, August 27, 2017 at 3:00 PM. Mt Pleasant Missionary Baptist Church Baptist Church at 4077 Prince Hall Blvd, Orlando, FL Attend the Eminence Information Meeting: September 10, 2017 at 2:00 PM, Mt Pleasant Missionary Baptist Church Baptist Church at 4077 Prince Hall Blvd, Orlando, FL Student Participant Eligibility: Applicants must be juniors and seniors in the Greater Orlando area in the Graduating Class of 2018 or Application Requirements: A completed and signed application. Application deadline is October 15, An autobiographical essay (minimum 150 words) or less than 3-minute video reel. Tell us about yourself, your interests, goals, favorite quotation and why you want to be selected as a Debutante or Distinguished Gentleman. A copy of most recent report card (preference given to those with a 2.0/4.0 GPA or higher). One sealed letter of recommendation from a school official (such as an administrator, teacher or counselor). One sealed letter of recommendation from a person NOT associated with your school and who is NOT a family member (acceptable entities include: any community organization, employer, clergy member). Application items must be mailed to: Delta Sigma Theta Sorority, Inc. - Orange County Alumnae Chapter Attn: Eminence Gala P. O. Box Orlando, FL Participation Requirements: Every effort must be made to attend all presentation workshops and activities. Schedule of activities will be provided. You and your parent/guardian must attend all dance rehearsals unless a valid excuse is given prior to the rehearsal. Empowerment Session Attire: Neat, clean and casual clothing. Appropriate length pants, shorts and skirts. Belly shirts and low riding pants are unacceptable. Formal attire is required during the Gala. Debutantes must wear a formal gown (ex: a white wedding gown type with no train), Distinguished Gentlemen must wear black tuxedo with tails at the evening of presentation, Saturday, April 8, Participation Fees: A $250.00* non-refundable participation fee is required. The non-refundable fee is used to offset costs for workshops, activities, pictures for program book, Eminence shirt, formal photo package and social events. The Fee may be paid in full or in up to three installments Eminence Gala xxxxxxxxxxxxxxxxxxx Page 3 of 12 (v617)

4 $100 due with submission of Application $75 Due by Sunday, November 12, 2017 $75 Due by December 17 th, 2017 *The Orange County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. is committed to providing opportunities for all youth interested in participating in our youth programs Should there be a financial hardship and payment of the participation fee is difficult. Please contact the Eminence Chair directly. The check or money order for the participation fee should be payable to the Orange County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. Please indicate Eminence Gala Participation Fee on the memo line of the check or money order. Mail to: OCAC Delta Sigma Theta Sorority, Inc., Attn: Eminence Program, P. O. Box , Orlando, FL SPONSORSHIP AND INCENTIVE INFORMATION Additional instructions regarding the solicitation of sponsorship for support will be provided at a later date. However, here is a brief overview of options available and the incentive paid: Participants are strongly urged to collect minimum of $1, in support and sponsorships. Once minimum of $1500 is met, the honoree will be provided 2 complimentary tickets for a guest to attend the Eminence Gala. Each honoree will receive a minimum incentive of 50% of all financial support and sponsorships submitted (Gala tickets are not counted as part of monies raised). o Top student will receive an incentive of 65% of all financial support o Second place student will receive 60% of all financial support o Third place student will receive an incentive of 55% of all financial support Support Opportunities and sponsorship opportunities are as follows: Event Sponsorship (see Eminence Committee member for more details) o Platinum Sponsor = $5, (10 tickets) o Gold Sponsor = $2, (10 tickets) o Silver Sponsor =$1, (5 tickets) o Bronze Sponsor = $ (2 tickets) o Copper Sponsor = $ (1 ticket) o Crimson Sponsor= $ (no tickets) o Cream Sponsor= $50.00 (no tickets) o Patron = amounts donated below $50 (no tickets) For additional information, please contact: Kerline Docteur, Eminence Committee Chair, at eminence@dstorangecountyfl.com ( ) Eminence Gala xxxxxxxxxxxxxxxxxxx Page 4 of 12 (v617)

5 Delta Sigma Theta Sorority, Inc. Orange County Alumnae Chapter Eminence Gala P. O. Box Orlando, FL APPLICATION (Please Print Legibly or Type) PERSONAL INFORMATION Full Name: Date of Birth: Address: City: Zip: Home Phone: Cell: School: Grade: Cumulative GPA address: Parents /Guardians Names: Address: (if different) Home Phone: Cell: Parent s address: School Activities Hobbies & Talents Eminence Gala xxxxxxxxxxxxxxxxxxx Page 5 of 12 (v617)

6 Organizational Involvement (community, church) Honors & Awards Are you currently a participant in a Delta Sigma Theta Sorority, Inc. Youth Group: Yes No Delta GEMS EMBODI Chapter: T-Shirt Size: X-Small S M L XL XXL XXXL What do you feel you would gain from being in the Eminence Program?*** (Please provide your answer below.)*** Participant's Signature: Date (By signing, you verify this information is truthful and complete) APPLICATION DEADLINE - OCTOBER 16, Eminence Gala xxxxxxxxxxxxxxxxxxx Page 6 of 12 (v617)

7 RISK MANAGEMENT FORMS/AUTHORIZATION AND RELEASE Photo/Video Authorization and Release I, as parent or legal guardian of, give permission for her/him to be photographed and videotaped. My signature gives consent to the Orange County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. to publish on the Internet or media still photographs or moving images, including, if applicable any sound recordings accompanying the images taken of my child while in the Eminence Program, without payment or any consideration and without notifying me. I understand and agree that these images will become the property of the Orange County Alumnae Chapter, which shall have complete ownership of the Images. I agree to hold harmless and release and forever discharge Eminence Program/Orange County Alumnae Chapter and any of its officers and members, national executive board, employees, representatives, and agents from any and all liability arising from or in connection with the taking, use, publication, or dissemination of such materials. Copies of these photos may be distributed to the parent upon request. Parent/Guardian s Name (Printed): Parent/Guardian s Signature: _ Date: Youth Pick Up Authorization I authorize the persons listed below to pick up my child from the Eminence youth initiatives program. For my child s safety, I understand that all authorized persons on the list below will be asked to show photo identification before my child is released to them; therefore I will notify all authorized persons of this requirement so that they will be aware and prepared. Name: Relationship: _ Name: Relationship: _ Name: Relationship: _ Name: Relationship: _ Name: Relationship: _ Field Trip Authorization I, as parent or legal guardian of, give permission for her/him to participate in the Eminence Program s activities taking place off site. I understand that transportation to and from these activities will not be provided for my child by the Orange County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. I understand that the field trips are part of the program and if I choose to not have my child participate in one or more off-site activities, I must make other care arrangements for my child during the times of that field trip activity. I assume all risks and hazards of loss or injury of any kind that may arise in connection with such trips, except for gross negligence or intentional infliction of harm by the Eminence Program, its officers, agents or employees. I do hereby agree to release and hold harmless the Eminence Program/Orange County Alumnae Chapter of Delta Sigma Theta Sorority, Inc, its officers, National Executive Board, employees, members, representatives, agents and assigns from any and all claims, costs, suits, actions, judgments, and expenses for any damage, loss, or injury to my child or damage to my child s property arising from my child s participation in field trips, other than damage, loss, or injury that results from gross negligence or intentional infliction of harm by the Eminence Gala xxxxxxxxxxxxxxxxxxx Page 7 of 12 (v617)

8 Eminence Program/Orange County Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated, its officers, National Executive Board, employees, members, representatives, agents and assigns. Parent/Guardian s Name (Printed): Parent/Guardian s Signature: _ Date: Emergency Contact Information 1) Name: Relationship: Street Address: City: State: Zip Code: Home Phone: Cell Phone: Cell address: 2) Name: Relationship: Street Address: City: State: Zip Code: Home Phone: Cell Phone: Cell address: Medical Information The health of the participant is the responsibility of her/his parents or guardians. The Orange County Alumnae Chapter strongly recommends annual health examinations and dental checkups. Our policy on health and safety implies a responsibility to the participants for their protection. It also implies the right of Delta Sigma Theta Sorority, Inc. to be assured, as far as possible, that the participants are physically able to take part in the activities of the program. Does child have any significant health history, conditions, communicable illness, or restrictions that may affect child s participation in the Eminence Program? (Circle one) None Yes If yes, please provide detailed explanation Does child have any significant food/medication/environmental allergies that may require emergency medical care during the Eminence Program? (Circle one) None Yes If yes, please provide detailed explanation Eminence Gala xxxxxxxxxxxxxxxxxxx Page 8 of 12 (v617)

9 Specify any other serious or severe illnesses or accidents: Does child take prescribed medications? If yes, name the medications: Does the Participant use any special device(s) (i.e. hearing aids, cochlear implants, etc.)? (Circle one) None Yes Name the Device(s): Reason for use: _ Medical Authorization In the case of a medical emergency, I understand that every effort will be made to contact the parents or guardian of the child. In the event that I cannot promptly be reached by phone, I hereby give permission to seek and secure any emergency medical or surgical care for my child. I will be responsible for any and all expenses incurred and authorize the medical facility at which treatment is rendered to release all necessary information to my insurance company. Parent/Guardian s Signature: _ Date: Non Prescription Medication Authorization PLEASE CHECK those medications you give permission for your child to receive (generic equivalent included). I understand that medications will be administered with discretion by an authorized member of the Eminence committee and in accordance with established protocols developed by Orange County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. The following nonprescription medications may be available to your child: For headaches/fever/muscle aches/pain/cramps: Acetaminophen (e.g., Tylenol), Ibuprofen (e.g., Advil, including Children s liquid, Motrin), Naproxen (Aleve), Midol, & Excedrin For bites/allergic rashes: Anti-itching lotion (e.g., Calamine or Hydrocortisone cream 1%), Benadryl liquid or capsules For nasal congestion/sinus pressure: Decongestant For coughs and sore throat: Throat lozenges For upset stomach: Antacid liquid or chewable tablets (e.g., Mylanta) For sun protection: Sunscreen lotion SPF 30 I DO NOT WANT ANY MEDICATIONS GIVEN TO MY CHILD Parent/Guardian s Signature: _ Date: Eminence Gala xxxxxxxxxxxxxxxxxxx Page 9 of 12 (v617)

10 Physician and Insurance Information Participant s Name: D.O.B.: Name of Physician: Phone: Health Insurance Company: Phone: Policy Number: Phone Number: Waiver and Release Group Number: Name of Policy Holder: I, as parent or legal guardian of, do hereby release, waive, discharge, covenant not to sue and agree to hold harmless Delta Sigma Theta Sorority, Incorporated, its officers, National Executive Board, employees, members, local chapters, representatives, agents, affiliates, and assigns, from any and all claims, demands, and actions of any and every kind directly or indirectly arising out of, or relating in any respect my child s participation in the Eminence Program. My waiver and release of all claims, demands, actions, and liability shall include without limitation, any injury, illness, death, property damage or loss to my child which may be caused by any act, or failure to act, by the Eminence Program, unless such injury, illness, death, property damage or loss is a direct result of the willful misconduct. I understand that, without limitation of the foregoing, neither Delta, nor the Program, shall be liable and each is hereby released from all claims that may arise from loss or damage to my child s personal property. Parent/Guardian Signature: Date: Eminence Gala xxxxxxxxxxxxxxxxxxx Page 10 of 12 (v617)

11 Delta Sigma Theta Sorority, Inc. Orange County Alumnae Chapter Eminence Gala P. O. Box Orlando, FL Letter of Recommendation From A School Official The following student is seeking to be a participant in the Orange County Alumnae Chapter s Eminence Program. Please complete the following information and return to the applicant in a sealed envelope with your signature. Applicant's Name (Print) 1. How long have you known the applicant? 2. In what capacity have you known the applicant? 3. Based on your knowledge of the applicant, please complete the following: Intellectual Ability Leadership Creativity and Imagination Maturity and Judgment Motivation and Initiative Personal Integrity Ability to get along with peers Poise Outstanding Good Fair Poor Please use the space below to make additional comments (A separate sheet may be attached) Signature Date Name (Print) Title School Phone Eminence Gala xxxxxxxxxxxxxxxxxxx Page 11 of 12 (v617)

12 Delta Sigma Theta Sorority, Inc. Orange County Alumnae Chapter Eminence Gala P. O. Box Orlando, FL Letter of Recommendation From A Non-School Official (For Community Leaders or Member of Delta Sigma Theta Sorority, Inc.) The following student is seeking to be a participant in the Orange County Alumnae Chapter s Eminence Program. Please complete the following information and return to the applicant in a sealed envelope with your signature. Applicant's Name (Print) 1. How long have you known the applicant? 2. In what capacity have you known the applicant? 3. Based on your knowledge of the applicant, please complete the following: Intellectual Ability Leadership Creativity and Imagination Maturity and Judgment Motivation and Initiative Personal Integrity Ability to get along with peers Poise Outstanding Good Fair Poor Please use the space below to make additional comments (A separate sheet may be attached) Signature Date Name (Print) Title Company/Organization Phone Eminence Gala xxxxxxxxxxxxxxxxxxx Page 12 of 12 (v617)